Guest Blog: Compassion – a MARLARKEY or a CASE FOR CHANGE?


Maxine 2014This is a guest blog from my friend and colleague Maxine Craig who is Head of Organisation Development at South Tees NHS Trust and visiting Professor ( Sunderland University).

Maxine can be found on Twitter on @Maxine_craig and she would welcome conversations about this blog.

Maxine’s blog speaks for itself – so here it is:

This week whilst at a training event in the coffee break a lady approached me and asked me “Was I Maxine Craig who is part of this ‘NHS Compassion Malarkey’? ” – now this has hit a nerve!

Maxine nursing

I have worked in the NHS since I was 17 and this ‘malarkey’ has been my life for 33 years. Ensuring patients get the best we can give and staff are well and healthy is my purpose. It’s no malarkey!

 

This is what a malarkey is:

malarky

I believe there is a compelling case for change in the delivery of care; the latest Panorama programme surely reinforces that? – Yet I sense that a back lash about compassion is building.

For the past year I have been making myself available to help people think about the issues we face, making spaces where people can think more deeply about compassion in our lives. And I am learning that everyone I speak to in the NHS, social care and wider society recognises that something about it needs fixing. Everyone appears to have a perspective on the general lack of compassion in the wider world and that the NHS needs to ‘do’ compassion better.

elderly lady

This is a real puzzle for me. I work in a great organisation and I witness compassion every day, in abundance, and I see situations where compassion in lacking; It’s not as clear cut as the media would have everyone think. I am worried that being compassionate is becoming an industry in our health and social care settings, others also express this view and some are becoming cynical of anything with a compassion label. I would like us to pick out and continue the genuine good work.

In all of my learning I have found that people find talking about compassion rather uncomfortable. Yes, everyone has an opinion, a surface view. Some people have been deeply affected by a positive experience of compassion in their lives and some hurt by a gap in compassion. Everyone who comes to talk about compassion has some interest, and I have noticed that many have some degree of discomfort.

angry womanI think this is because it’s about all of us, not just the bad guys who don’t do it! It has the potential to make us feel guilty, uncomfortable about our personal struggles and challenges.

At a system level the NHS voices that it wishes to improve compassion but it continues to work in a non-compassionate way and I suspect the care sector is the same. This is a paradox. I do not believe this is a ‘problem’ that needs to be solved but see it as more of a societal context, leaving me as an OD practitioner with a complex and sometimes frustrating dynamic to work in. So I am working to explore and practice the ‘HOW’ of increasing compassion in our system – I want to get on and DO something about it not just talk about it!
 

The NHS is deeply evidence based. In some parts this might be more espoused theory than theory in use, but it is an important guiding principle. We also wear the cloak of evidence as a defence. Another important fact is that many professionals and managers (and I include myself in this group), actually were professionally socialised at a point in time when the control of emotions and ‘not getting emotionally involved with the patient’ were prized professional competences. The new world of the psychology of work offers a different view, with burn out, compassion fatigue and emotional labour as key and important phenomenon. It is important we remember the shift which has occurred within one generation. As a result of this shift the current reality of the compassionate intervention is very challenging for some.

the compassionate mindSo I have learned that the very best way into these conversations about compassion and the psychology of work and caring is via the science. The work of Paul Gilbert who established the Compassionate Mind foundation gives us the basis of the neuroscience of emotion (you can read more here) and I have been able to link this to stress in life and wider society.

Tree huggingI have witnessed the relief in people when they come to talk about compassion and are met with the evidence base. It welcomes them in, it is a context they know, it allows them to be open to the practice of compassion. When coming to a talk about compassion people have shared with me that they were worried it would be too soft and fluffy. When I have explored what this means some people say they don’t want ‘new age’ or religious or spiritual. So like all good change agents let’s start where people are at – let’s start with the science!change agent

Compassion is no malarkey; it’s vital and too important to be pushed aside because it makes us uncomfortable.

I am DIGGING IN for the long haul on this one – I want to make sure the NHS and care system is good enough for my dad. Will you join me?

Maxine's Dad

Where is your change preference?


figure headSometimes life throws you an opportunity to explore something new or even explode things you thought you knew. Often you think you know what enthuses you but then you surprise yourself; I once surprised myself white-water rafting in the Ottawa River – I was like the figure-head on the front of a ship, holding on bravely – but I digress! This time it was a new opportunity to explore and expand some knowledge.  As part of my Florence Nightingale Foundation Burdett Scholarship I have been very lucky to spend some time at Roffey Park  and a few weeks ago I was there looking at change management.

So we looked at a number of theoretical change models. That was interesting enough; I knew some and was less familiar with others. Then the interesting bit started, we tried putting them along a scale according to what I have termed humanist > mechanistic approaches. What I call humanist are what is termed ‘relational’ where enabling techniques like World Café, Future Search and Appreciative Inquiry have their place. At the opposite end of the spectrum was more mechanistic project management type approaches, that are less messy and are organised in a more logical flow led by theorists such as Lewin and to a degree Kotter; they have a more linear and analytical style with techniques like business process mapping and lean methodology. Of course the scale is not a scientific one and it is matter of personal interpretation and perspective.

change

I had a sudden moment of clarity. The process of learning led me to think about my personal preferences and how I liked to think about change. I discovered that although I see that different approaches have different strengths and weaknesses, I had a personal preference for the type of approach to change that I liked to be involved in. I also saw that not only had I personal preference for any approach to change, that I worked in organisations that equally had a culture with a leaning towards an approach, and finally that there was an opportunity for discomfort and tension in this.

BridgesMy favourite model was a new one to me and is a model called ‘Transition Management’ based on the work by William Bridges. It refocuses change into transition, which is the psychological transition and reorientation required in response to change. I loved the idea that before we can transition we need to address endings and then we inevitably experience a neutral zone, a period of chaos and an in-between time. Then the process of renewal starts. I loved the language of this model. Words like: endings, relationships, resistance, disorientation, beginnings and new identity. If you want to know about Bridges have a look at this article here.

Gant chartSo, I like a particular approach to change but I work in an area that clearly can’t use that approach, you can’t introduce new software using appreciative inquiry – you need good Gantt charts plenty of them! If you work in the large scale programmes I work in you are nobody if you don’t have a Gant chart or a RAG status!  But I survive there despite my preferences – I had to think hard about why!

My conclusion was that I am able to see that its appropriateness that matters most and having people around who have the skills to use the right approach. Organisational development people are not one-trick ponies they need to be able to work out what is the best way and then use it. I’m just glad that with my preferences for relational models of change I work with some great people who have skills at the other end of my change spectrum – It made me think about difference and value it even more!

At a time where there is a need for unprecedented change in the NHS, understanding our personal preferences and leanings as well as the embedded culture of organisations and their almost instinctive responses to the need for change has to be important learning.

standing out from crowd